- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $6,104.95 / $19,415.45
| Facility | | $2,264.00 | $6,104.95 | $19,415.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,567.00 / $21,112.00 / $36,529.00
| Facility | | $2,567.00 | $21,112.00 | $36,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.67 / $1,308.66 / $1,738.07
| Facility | | $1,019.67 | $1,308.66 | $1,738.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.96 / $7,340.48 / $19,195.70
| Facility | | $1,300.96 | $7,340.48 | $19,195.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.96 / $128.96 / $128.96
| Facility | AS | $128.96 | $128.96 | $128.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,351.00 / $11,727.00 / $21,867.00
| Facility | | $5,351.00 | $11,727.00 | $21,867.00 |